COVID-19 Stories

As a pediatric intensivist in New York City, I would like to salute all the pediatric and other providers. They are extending themselves, or have been redeployed, to care for patients they usually do not. Across NYC, pediatric residents and fellows have volunteered—or been sent—to adult units. They are caring for adults with COVID-19. At my PICU at Columbia University, we have a sizeable number of adults (we are not used to patients in their 40s and 50s) with COVID-19. They are intubated and even on extracorporeal support. We also have had probably the largest number of critically ill children with COVID-19 in the U.S.—some with acute respiratory distress syndrome (ARDS) and some with severe non-respiratory illnesses from COVID-19. Everyone is doing his or her part.

Pothole or Portal

The streets of New Orleans

               are known for their potholes

                              ever present         varying in shape and depth

                              often not seen until too late

walking or driving along without a care

 you are caught off guard

                                             jolted

               just how much injury has happened

you’ll discover that with your next move

now

you are told to stay at home

and think you might be safe

but inside you begin to recognize there are similar difficulties

internal potholes that seem to have been hidden

amidst the busy-ness and speed of everyday life

               now temporarily that noise has been silenced

                              and you are left with the ruts in your road

and given the stress of your isolation they deepen

and become harder to see and avoid

you fall into fear

and then into anger

                                             and then into grief

                                                            and then into regret

you’ re not good enough

you ‘re not doing enough

it’s your fault

you chose the wrong path

now

look to your left

               look to your right

are you with people alongside you           arm in arm

or do you feel alone

and lonely

what can be done to transform your potholes into portals?

what I mean by this is

instead of tumbling into hurt

                                             and having to climb out

you pass through

               to a new place where you’ve not been before

                              where your fear becomes your nerve

                              and your worry becomes your hope

               where that which has been holding you back

now urges you on

where the jolt is now two elbows touching

               encouraging a connection that is flexible and strong even if momentary

where injury and pain are expected because you care as you do

as you stride on with humility and daring

the road remains the road

you are different

               you see the difficulties as challenges

               you feel  the ground and do not doubt its ability to support you

               you accept that with all that you are not you can still inspire

                              and bring hope and love to those around you

Inside this portal you will not be deterred

When the coronavirus pandemic first broke on the news, we were inundated with patient and physician emails, texts, and phone calls. We have several thousand patients on biologic therapies, many of which were based on work done in our department. All were concerned about the possibility that these treatments would suppress their immune system and make them more susceptible to COVID-19. We reviewed and quickly published data from pivotal trials comparing viral respiratory infections for the biologic treatments for psoriasis and atopic dermatitis to their placebo controls. These became the source of recommendations made by several patients and medical organizations on the management of patients on those medications during the pandemic. That was easy compared to the clinical challenges at Mount Sinai. Despite converting all of my office visits to telemedicine, I had to come to work every day because our 26 residents and large staff were spread out among Mount Sinai’s eight main hospitals, leaving only a skeleton crew for Dermatology. Many of them contracted COVID-19 and fortunately, all are recovering. There is no doubt that the “all hands on deck” call at Mount Sinai saved the lives of many New Yorkers.

My days right now are spent in a virtual [virtuous] world that begins just before the sun comes up. East Coast colleagues begin their daily toils whilst most here are asleep, except the birds and worms and me.

In my role as the Medical Director of RICHER, an outreach Social Pediatrics program, to our Inner City, and my other foot in the BC Children’s Hospital as the Medical Director of our provincial Cleft Palate Craniofacial Program, I have had to learn how to schedule and coordinate meetings on several platforms, keeping our distances, but promoting our social capital. My academic “social contract” with UBC is to provide learning and research opportunities to medical students and other trainees who have a passion for addressing inequities in access and outcomes for children and youth with special needs.  

Our RICHER program, described as linking in and linking across, addresses the financial and social inequities to access in the inner-city schools and neighborhoods in our otherwise very wealthy city. This is ground zero for the opiate epidemic, on the heels of homelessness and HIV, and a not so hidden mental health desert. Our hospital-based cleft palate team works with families who experience the added stressors of disability, distance, and discrimination.

I am deeply involved in the Veterans Administration as both a clinical chief and a researcher leading a COVID-19 effort in the Veterans Administration Million Veteran Program.